NR 565 / NR565 FINAL EXAM

NR 565 / NR565 FINAL EXAM I understand the value of doing my own work and learning this skill to support my future independent practice as a nurse practitioner. I understand that while there may be opportunities beyond my faculty’s control to collaborate or share answers with peers, that it would not benefit my own personal and professional growth to do so. I agree to do my own work and take personal responsibility for my learning. I do not. I do. Use the John Jones case study to answer the following question. Which glucose level equates with a Hgb A1C of 8.1%? ~204 mg/dl ~160 mg/dl ~175 mg/dl ~183 mg/dl The correct answer is ~183mg/ dl. See page 400, Table 48.4, Hemoglobin A1c levels and their corresponding eAG levels for complete information. Use the John Jones case study to answer the following question. John calls the office and reports that he is scheduled for diagnostic testing that requires IV contrast for imaging. He inquires if there are concerns with undergoing this procedure while taking his medications. What instructions should be given to John regarding his metformin regimen? Don’t take the metformin the day of the procedure and for 48 hours afterward. No special instructions are Take the metformin the morning of the procedure but don’t take it for 48 hours afterward. Don’t take the metformin the day of the procedure but resume the following day. Metformin must be withheld on the day of the procedure and for 48 hours afterward. Serum creatinine levels should be normal before resuming metformin. Use the John Jones case study to answer the following question. Which of the following lab test should be evaluated before prescribing metformin? Complete blood count (CBC) Complete metabolic profile (CMP) Lipid Panel Urinalysis CMP provides a baseline evaluation for both hepatic and renal function which should be evaluated throughout treatment with metformin. Use the John Jones case study to answer the following question. Which behavior in John’s social history poses a potential concern with initiating metformin? His diet largely consists of fast-food meals. He drinks sweet tea with every meal. He reports drinking “a few beers on the weekend during football season”. No answer text He drinks 3-4 cups of coffee per day. Metformin is contraindicated in alcoholics. Although it does not sound as if John is an alcoholic, further questioning is needed, and the discussion should be documented. Metformin taken by alcoholics increases the risk of lactic acidosis so John should be educated on this risk along with signs and symptoms of lactic acidosis. Use the John Jones case study to answer the following question. Metformin works by decreasing and . glucogenesis; incretin secretion incretin secretion; insulin production Correct Answer glucogenesis; insulin resistance insulin resistance; incretin secretion Metformin decreases glucogenesis and insulin resistance. Use the John Jones case study to answer the following question. Using the ADA Standards of Medical Care in Diabetes-2020, which of the following medications should be prescribed for John? Canagliflozin Glyburide Dulaglutide Metformin According to the ADA Standards of Medical Care in Diabetes-2020, Metformin is the first-line medication to prescribe for patients with a HgbA1C 6.5%. American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes —2020 Abridged for Primary Care Providers. Use the John Jones case study to answer the following question. Which of the following statements best describes John’s status? He has diabetes and requires pharmacological intervention. He does not have diabetes. He has diabetes but does not require pharmacological intervention. He has pre-diabetes. DM Diagnostic Criteria on pg 398 reviews the four criteria to diagnose DM which is the precursor to pharmacological intervention. These criteria include: • Fasting plasma glucose ≥126 mg/dLa Or • Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes Or • Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200 mg/dLc Or • Hemoglobin A1c 6.5% or higher; Use the John Jones case study to answer the following question. John’s triglycerides are 260 mg/dl and his HDL is 35mg/dl. Referring to the ADA Standards of Medical Care in Diabetes-2020, what is the correct action to take at this time? Increase John’s atorvastatin to 20mg per day. Leave John’s atorvastatin as is and re-check lipids when A1C is re-checked. Increase John’s atorvastatin to 40 mg per day. Stop John’s atorvastatin since he is now being treated for diabetes. According to the ADA Standards of Medical Care in Diabetes-2020, the correct action is to intensify lifestyle therapy and optimize glycemic control for patients with elevated triglyceride levels (≥150 mg/dL [1.7 mmol/L]) and/or low HDL cholesterol (40 mg/dL [1.0 mmol/L] for men, 50 mg/dL [1.3 mmol/L] for women). John's treatment includes lifestyle changes as well as metformin which aligns with practice guidelines. John’s atorvastatin should remain as currently prescribed with monitoring of lipid profile and A1C. Use the John Jones case study to answer the following question. What is the recommended interval for monitoring John’s HgbA1C? 1-month 6-weeks 3-months 6-months The HgbA1C is a 3-month average of glucose; therefore, it should be re-checked in 3 months after starting treatment. Checking this lab value beforehand will provide a mixed result of glucose before and after treatment. Monitoring blood sugar between the beginning of treatment with metformin and a 3 month follow up, fasting finger stick blood sugars should be done. Use the John Jones case study to answer the following question. Which of John’s behaviors should be addressed to encourage lifestyle changes and decrease A1C levels? Select all that apply. He drinks 3-4 cups of coffee per day. Sits at a desk several hours a day. Weight 235lbs His diet largely consists of fast-food meals. He drinks sweet tea with every meal. Family history is significant for diabetes. Correct Answer BP 130/90 The combination of moderate exercise and weight loss reduces the risk for the development of type 2 diabetes and improves outcomes for patients with type 2 diabetes (Rosenthal & Burchum, 2021). Use the Alfonso Giuliani case study to answer the following question. Which lab test is necessary to evaluate before prescribing a sodium/glucose cotransporter-2 inhibitor (SGLT2i)? CBC LFTs HgbA1C CMP A complete metabolic profile (CMP) is needed to evaluate GFR before prescribing a SGLT2i. Use the Alfonso Giuliani case study to answer the following question. Alfonso should be started on statin therapy to address his high total cholesterol and low HDL. True False Statin therapy is recommended because of his known diabetes and 10-year risk ≥7.5%. If Alfonso’s LDL is 70mg/dl (1.81 mmol/L), additional factors like lifestyle and risk-benefits may be considered before starting statins. Identify SGLT2i agents in the list below. Select all that apply. linagliptin dapagliflozin alogliptin sitagliptin saxagliptin canagliflozin empagliflozin The Food and Drug Administration (FDA has approved three SGLT2 selective inhibitors for mono, dual, and triple therapy: canagliflozin (Invokana®), dapagliflozin (Farxiga®), and empagliflozin (Jardiance®) Question 15 0 / 2 pts Use the Alfonso Giuliani case study to answer the following question. Use the ASCVD Risk Estimator-Plus calculator (Links to an external site.) to estimate Alfonso’s ASCVD Risk score. Which of the following scores is his ASCVD Risk score? 31.2% 37.6% Correct Answer 46.5% 52.1% Alfonso’s ASCVD Risk score is 46.5% according to ASCVD Risk Estimator-Plus tool, which estimates risk based on age, gender, presence of diabetes, treatment for hypertension, cholesterol values, and systolic pressure. Use the Alfonso Giuliani case study to answer the following question. Which of the following benefits from GLP-1 therapy are helpful to Alfonso? Select all that apply. appetite suppression weight loss Correct Answer low risk for hypoglycemia blood pressure control The benefits of GLP-1 therapy relevant to Alfonso include weight loss and suppression of appetite without causing hypoglycemia. Question 17 0 / 2 pts Use the Alfonso Giuliani case study to answer the following question. Which statin agents and dosages are consistent with the statin therapy intensity Alfonso needs? Select all that apply. Atorvastatin 10-20 mg Correct Answer Rosuvastatin 20-40 mg Correct Answer Atorvastatin 40–80 mg Pravastatin 40-80 mg High-intensity statin therapy options include Atorvastatin 40–80 mg and Rosuvastatin 20-40 mg. These are agents best suited for Alfonso. Treatment agents are identified under the evidence tab of the ASCVD Risk Calculator. Use the Alfonso Giuliani case study to answer the following question. Which of the following lab values are important to monitor while taking GLP-1 agents? hemoglobin and hematocrit Correct Answer amylase and lipase aspartate transaminase & alkaline phosphatase magnesium and calcium GLP-1 drugs may cause pancreatitis. GLP-1 drugs do not cause cellulitis, diverticulitis, and cholecystitis. Question 19 1.6 / 2 pts Identify GLP-1 agents in the list below. Select all that apply. exenatide semaglutide dulaglutide lixisenatide liraglutide rosiglitazone pioglitazone albiglutide GLP-1 receptor agonists include: albiglutide (Tanzeum) dulaglutide (Trulicity) exenatide (Byetta) liraglutide (Victoza) lixisenatide (Adlyxin) semaglutide (Ozempic, Rybelsus) Use the Alfonso Giuliani case study to answer the following question. Which of the following complications may be caused by GLP-1 agents? diverticulitis cholecystitis pancreatitis Correct Answer cellulitis GLP-1 drugs may cause pancreatitis. GLP-1 drugs do not cause cellulitis, diverticulitis, and cholecystitis. Use the Alfonso Giuliani case study to answer the following question. Considering Alfonso’s ASCVD risk score, which of the following diabetic drug classes should be considered in addition to metformin? TZD SGLT2i Correct Answer GLP-1 Sulfonylurea According to the ADA Standards of Medical Care in Diabetes-2020, GLP-1 and SGLT2i drugs are recommended in conjunction with metformin when ASCVD risk predominates. Alfonso meets this criterion with an ASCVD risk score 40%. American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes —2020 Abridged for Primary Care Providers. Question 22 0 / 2 pts Use the Alfonso Giuliani case study to answer the following question. Which of the following types of statin therapy should be started for Alonso? Correct Answer High-intensity statin therapy Low-intensity statin therapy Moderate-intensity statin therapy High-intensity statin is recommended for Alfonso because of his known diabetes and 10-year risk ≥7.5%. If Alfonso’s LDL is 70mg/dl (1.81 mmol/L), additional factors like lifestyle and risk- benefits may be considered before starting statins. Use the Helen Smith case study to answer the following question. Helen’s has abnormal thyroid values: TSH 24 mU/L Free T4 0.2 ng/dl What condition do these tests indicate? Hashimoto’s thyroiditis Hypothyroidism Grave’s Disease Hyperthyroidism Helen’s abnormal thyroid values are consistent with hypothyroidism due to decreased thyroid hormone levels. Hyperthyroidism and Grave’s Disease result from elevated thyroid hormone levels. Hashimoto’s thyroiditis is an autoimmune condition of the thyroid that can not be diagnosed by TSH and Free T4. What are the Black Box Warnings associated with NSAIDs? Select all that apply. Increases risk for GI bleeding, ulceration, and perforation Increases risk for cardiovascular thrombotic event Increases all-cause mortality Increases risk for serious skin reactions Black Box warning on NSAIDs: Cardiovascular Thrombotic Event NSAIDs incr. risk of serious and potentially fatal cardiovascular thrombotic events, incl. MI and stroke; risk may occur early in treatment and may increase with duration of use; contraindicated for CABG perioperative pain GI Bleeding, Ulceration, and Perforation NSAIDs incr. risk of serious and potentially fatal GI adverse events incl. bleeding, ulcer, and stomach or intestine perforation; GI events may occur at any time during use and without warning signs or symptoms; elderly pts and pts with hx of PUD or GI bleeding at greater risk for serious GI events Use the Helen Smith case study to answer the following question. Which of the following criteria support’s Helen’s diagnosis of DM? (Select all that apply) Glucose: 189 mg/dL T. Cholesterol 240 mg/dl polyuri Correct Answer Triglycerides 260 mg/dl HgbA1C: 9.2% nocturia The following criteria support Helen’s diagnosis of DM, HgbA1C: 9.2%, Glucose: 189 mg/dL, polyuria, nocturia, and triglycerides 260 mg/dl. Although the A1C is the definitive diagnostic value, the other values also support this diagnosis when accompanied with an elevated A1C. Use the Helen Smith case study to answer the following question. If the standard starting dose of levothyroxine 1.6 mcg/kg/dose is prescribed for Helen, what is the correct dose? 200mcg Correct Answer 175mcg 300mcg 150mcg The correct dose is 175mcg/dose. Calculations are 1.6 mcg/kg/dose. Helen weighs 242 pounds; therefore the dose calculation is 1.6mcg/110kg (242 pounds) or =175.63. Therefore, the closest available dose to order would be a 175mcg tablet. This is a high dose to start for an older patient with cardiac disease so it would be appropriate to choose a lower starting dose for Helen and titrate up. Use the Helen Smith case study to answer the following question. Why is caution indicated if metformin was prescribed Because metformin is contraindicated with her age. Correct Answer Because only diabetic medication should be prescribed. Because heart failure can predispose patients to lactic acidosis. Because metformin interacts with her Irbesartan. Heart failure (HF) may predispose patients to lactic acidosis; therefore, metformin is contraindicated for those with failing hearts. However, recent data suggests that patients with HF who took metformin were less likely to die than those who took a sulfonylurea. This data suggests that the use of metformin in HF may be safer than previously believed and should be used with extreme caution (Rosenthal & Burchum, 2021, p. 409) Use the Helen Smith case study to answer the following question. Which of the following lab values require consideration for possible treatment? Hgb 15.3 g/dL Alkaline phosphatase: 50 U/L Correct Answer Triglycerides 260 mg/dl TSH 24 mU/L Total Cholesterol 240 mg/dl Correct Answer HDL 35 mg/dl ALT (alanine aminotransferase): LDL 120mg/dl AST (aspartate aminotransferase): 20 Hct 48% Free T4 0.2 ng/dl The following lab values require consideration for possible treatment as they are not within normal limits: Total Cholesterol 240 mg/dl HDL 35 mg/dl LDL 120mg/dl Triglycerides 260 mg/dl TSH 24 mU/L Free T4 0.2 ng/dl Use the Helen Smith case study to answer the following question. What is the daily maximum dose of levothyroxine? 700mcg/day 500mcg/day 300mcg/day 1000mcg/day Levothyroxine has a maximum dose of 300 Use the Helen Smith case study to answer the following question. Which of the following medical conditions will determine Helen’s diabetes treatment regimen? Obesity Osteoarthritis Dyslipidemia Heart Failure According to the ADA Standards of Medical Care in Diabetes-2020, specific treatment for patients with heart failure is warranted. Dyslipidemia, obesity, and osteoarthritis are not determining factors for treatment according to these guidelines. American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes —2020 Abridged for Primary Care Providers. Use the Helen Smith case study to answer the following question. Which DM drug class is contraindicated in patients with heart failure? Sulfonylurea Biguanide GLP-1 TZD The ADA Standards of Medical Care in Diabetes-2020notes that TZD drugs should be avoided in patients with heart failure. American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes —2020 Abridged for Primary Care Providers. Use the Helen Smith case study to answer the following question. There is still one important issue to address with Helen today. Which of the following concerns requires addressing? Heart failure Fatigue Weight Cholesterol Helen’s cholesterol values are new and need to be addressed. Her heart failure is being treated and monitored by a cardiologist. Her weight is not a new issue; education regarding exercise and a diabetic diet is warranted to manage her blood sugar and diabetes. Her fatigue is addressed through the treatment of both diabetes and hypothyroidism. Use the Helen Smith case study to answer the following question. Which medication should be prescribed for Helen to address her thyroid levels? Triiodothyronine Methimazole Levothyroxine Propylthiouracil Levothyroxine should be prescribed for Helen to address her thyroid levels. Levothyroxine is a hormone that replaces the thyroid hormone that is normally produced by the body. Propylthiouracil and methimazole are both drugs to treat hyperthyroidism. Triiodothyronine is a T3 hormone that can be used in conjunction with levothyroxine to treat patients with Hashimoto’s thyroiditis. Use the Helen Smith case study to answer the following question. Medication lists should always be reviewed for evidence-based prescribing practices. Helen is taking Naproxen 500 mg PO every 12 hours. What is the maximum dose of Naproxen per day (for 6 months)? 2000mg per day 1000mg per day 2500mg per day 1500mg per day The maximum dose of Naproxen is 1500mg/day for 6 months. Use the Helen Smith case study to answer the following question. Which of the following agents should be prescribed for Helen? (Independent searching may be required to find the answer to this question) Glipizide Dapagliflozin Glimepiride Pioglitazone “SGLT2 inhibitors are the most recent drug class approved by the FDA for treating type 2 DM (T2DM). They work by inhibiting SGLT2 transport proteins in the proximal convoluted tubule (PCT) in the kidney. Because these transporters account for nearly 90% of all filtered-glucose reabsorption in the body, they are excellent targets for blood-glucose control. SGLT2 inhibitors have been associated with HbA1c reductions of 0.5% to 1%, making them effective second-line treatment options for T2DM” (Chim, Newaz, 2020, para. 3). Pioglitazone is a TZD, Glimepiride and Glipizide are both sulfonylureas. Chim, C. & Newaz, S. (2020). SGLT2 Inhibitors and heart failure outcomes. US Pharmacist. 45(2): 18-22. Use the Helen Smith case study to answer the following question. Which of the following drug classes should be prescribed for Helen? GLP-1 Biguanide SGLTi DPP-4i According to the ADA Standards of Medical Care in Diabetes-2020, Helen should be started on a SGLTi. Use the Helen Smith case study to answer the following question. Which of the following is the recommended initial dose of levothyroxine for the general population? 1.2mcg/kg/dose daily 1.8 mcg/kg/dose daily 2.0 mcg/kg/dose daily 1.6 mcg/kg/dose daily The recommended initial dose of levothyroxine for the general population is 1.6 mcg/kg/dose PO daily, then adjust dose by 12.5-25 mcg/day every 4-6wk. In the elderly and those with cardiac disease, begin levothyroxine 12.5-50 mcg/day, increasing by 12.5 mcg/day every 6-8wk. Starting Helen at a lower dose due to her heart disease may be a good idea to prevent cardiac symptoms. In youth who are overweight or obese and have a new onset of diabetes with an A1C8.5%, how much basal insulin is recommended? Correct Answer 0.1 units/kg/da 0.8 units/kg/day 0.5 units/kg/day 1 unit/kg/day According to the ADA Standards of Medical Care in Diabetes-2020, basal insulin should be started at 0.5 units/kg/day and escalate every 2-3 days based on self-monitoring of blood glucose (SMBG). Figure 13.1 American Diabetes Association. (2020). 13. Children and Adolescents: Standards of Medical Care in Diabetes− 2020. Diabetes Care, 43(Supplement 1), S163-S182. When considering older adults in the treatment and management of diabetes, what special considerations apply? Select all that apply. Screening for geriatric syndromes Current quality of life Social geriatric Correct Answer Self-management abilities According to the ADA Standards of Medical Care in Diabetes-2020, self-management abilities and social geriatric domains are special considerations. An assessment of medical, psychological, functional (self- management abilities), and social geriatric domains are warranted in older adults to provide a framework to determine targets and therapeutic approaches for diabetes management. A diabetic construction worker is seen for follow-up care. He has been taking metformin 1000mg PO twice daily for the last 3 months and his A1C is 8.7. Which section of the Standards of Medical Care in Diabetes—2020 best describes his treatment plan? Cost is a major issue Compelling need to minimize weight gain or promote weight loss Correct Answer Compelling need to minimize hypoglycemia ASCVD Predominates This patient is a construction worker; therefore, there is a compelling need to minimize his hypoglycemia due to work-related safety concerns. Working with heavy equipment or in dangerous locations poses safety risks associated with a sudden bout of hypoglycemia. Which of the following diabetic drug classes should be prescribed with metformin for a patient with a BMI of 52? Select all that apply. Insulin TZD DPP-4i SGLT2i GLP-1 According to the Standards of Medical Care in Diabetes—2020, the following classes should be prescribed with metformin for a patient with a BMI of 52 These are listed under the “Compelling need to minimize weight gain or promote weight loss” column of the guideline. American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes —2020 Abridged for Primary Care Providers. Which of the following agents are recommended when hypoglycemia is a concern? Select all that apply, Insulin SGLT2i DPP-4i Correct Answer GLP-1 TZD Sulfonylurea According to the Standards of Medical Care in Diabetes—2020, the following agents are hypoglycemia is a concern: DPP-4i, GLP-1, SGLT2i, and TZD. These agents are listed under the “Compelling need to minimize hypoglycemia” section of the guideline. American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes —2020 Abridged for Primary Care Providers. Which of the following hypertension drug classes are NOT recommended for the primary prevention of chronic kidney disease in patients who have diabetes with normal blood pressure and GFR? (Select all that apply) Correct Answer Angiotensin converting enzyme inhibitors Calcium channel blockers Correct Answer Angiotensin II receptor blockers Thiazide diuretics 11.9 According to the ADA Standards of Medical Care in Diabetes-2020, an ACE inhibitor or ARB are NOT recommended for the primary prevention of chronic kidney disease in patients in patients who have diabetes with normal blood pressure and GFR. American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes —2020 Abridged for Primary Care Providers. According to the ADA Standards of Medical Care in Diabetes-2020, what are the goals of care for diabetes? Select all that apply. Empower patients to manage their own disease process Prevent diabetic Correct Answer Maintain constant control of blood sugar Optimize quality of life According to the ADA Standards of Medical Care in DiabetesLinks to an external site.-2020, the goals of care are to prevent complications and optimize quality of life. This information is found on the Decision Cycle for Patient-centered Glycemic Management in Type 2 Diabetes. Exercise is recommended for all youth with type 1 diabetes with the goal of min of moderate- to-vigorous intensity aerobic activity daily, with vigorous muscle-strengthening and bone-strengthening activities at least days per week. 60;3 30;3 50;5 45;5 According to the ADA Standards of Medical Care in Diabetes-2020, exercise is recommended for all youth with type 1 diabetes with the goal of 60 min of moderate-to-vigorous intensity aerobic activity daily, with vigorous muscle-strengthening and bone-strengthening activities at least 3 days per week. American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes —2020 Abridged for Primary Care Providers. Which of the following is the preferred medication for treating hyperglycemia in gestational diabetes? Insulin DPP-4i GLP-1 Metformin TZD Glyburide SGLT2i According to the ADA Standards of Medical Care in Diabetes-2020, insulin is the preferred medication for treating hyperglycemia in GDM. Metformin and glyburide should not be used as first-line agents, as both cross the placenta to the fetus. Other oral and noninsulin injectable glucose-lowering medications lack long-term safety data and are not recommended. American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes —2020 Abridged for Primary Care Providers. Which classes of oral diabetic drugs carry a higher risk for hypoglycemia? (Select all that apply) SGLT-2 inhibitors Sulfonylureas Biguanides α-glucosidase inhibitors Correct Answer Glinides The oral agents work in a variety of ways. Some of them—notably the sulfonylureas, and glinides (collectively referred to as “insulin secretagogues”)—actively drive blood glucose down by increasing insulin release from β cells of the pancreas. Others—notably metformin (a biguanide), the α-glucosidase inhibitors, and SGLT-2 inhibitors—do not drive blood glucose down; rather, they simply modulate the rise in glucose that happens after a meal. This distinction is not just academic: if taken when blood glucose is normal or low, agents that drive glucose down can cause hypoglycemia. Hypoglycemia is not a large risk with the drugs that simply impair the postprandial rise in blood glucose (Rosenthal & Burchum, 2021, p. 408). Which of the following DM drug class has a warning that it can cause severe and disabling joint pain at any point in time during treatment? Metformin SGLT2i DPP-4i Insulin Glyburide TZD GLP-1 DPP-4i has a warning that these medications can cause severe and disabling joint pain at any point in time during treatment. Which of the following exams is important for diabetics and requires a referral? Colonoscop Eye exam Correct Answer Foot exam Gait evaluation An eye exam is needed for an evaluation of diabetic retinopathy and requires a referral. A foot exam can be done by a NP. A colonoscopy requires a referral when needed but a diagnosis of DM doesn’t warrant the automatic need for colonoscopy. Gait evaluation is not related to diabetes. A single mom who makes minimum wage and struggles financially needs an additional diabetic medication after experiencing minimal A1C improvement with metformin. Which of the following DM drugs is appropriate? Select all that apply. Dulaglutide Sitagliptin Canagliflozin Glyburide Pioglitazone Glucophage NPH Sulfonylurea (glyburide) and TZD (pioglitazone) are appropriate to prescribe when cost is a are in the two drug classes noted by the ADA when cost is a major issue. Match the A1C testing recommendations to the correct patient. Perform the A1C test at least two times a year Perform the A1C test quarterly